A consensus statement from the Global Alliance to Improve Outcomes in Acne outlines the core principles of an effective acne management strategy using the Delphi methodology. The statement was recently published in the Journal of the American Academy of Dermatology, with the goal being to help guide clinicians to understand the most efficient therapeutic strategies for acne that could easily be implemented in an office setting.
The investigators focused on areas in which the existing evidence base is less robust and expert opinion might play a role in refining practice patterns.
Topics that were identified for further discussion included acne grading, recent data on topical treatments, combination regimens in acne, and subjects of special interest, including acne among women, postinflammatory hyperpigmentation, and scarring.
A total of 10 consensus recommendations were identified by the panel:
- Retinoids have an essential role in the treatment of acne. For the majority of patients with inflammatory and/or comedonal acne, a topical retinoid plus benzoyl peroxide (BPO) is first-line therapy.
- The role of antibiotics in acne therapy has changed; neither topical nor systemic antibiotics should be used as monotherapy for acne treatment.
- Oral isotretinoin should be first-line therapy for very severe (cystic/conglobate) acne.
- Oral isotretinoin therapy should proceed until full clearance of acne. Additional studies are needed to define a total cumulative dose that maintains remission.
- Acne flare with oral isotretinoin can be minimized by initiating therapy with a low dose.
- Most patients with acne should receive maintenance therapy with a topical retinoid with or without BPO. Topical antibiotics should not be used as acne maintenance therapy.
- Azelaic acid cream 20% or gel 15% is a useful acne treatment in pregnant women and patients with acne and postinflammatory hyperpigmentation.
- At present, devices including laser, intense pulsed light, and photodynamic therapy should not be considered first-line treatment for inflammatory acne.
- A minority of women 25 years or older have acne lesions localized only to the lower face. Topical retinoids with or without BPO are important components in therapy of adult acne.
- Early and effective treatment is important to minimize the potential risk for scarring.
The investigators concluded that acne is a widespread disease, and dermatologists must take the lead in implementing best practices and educating other healthcare professionals about treatment strategies.
Thiboutot DM, Dréno B, Abanmi A, et al. Practice management of acne for clinicians: an international consensus from the Global Alliance to Improve Outcomes in Acne [published online November 7, 2017]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2017.09.078